The use of multimodal low-opioid anesthesia for coronary artery bypass grafting surgery in conditions of artificial blood circulation

Abstract

Introduction Cardiovascular diseases (CVD) are the main cause of death worldwide, and according to experts, they will continue to dominate the structure of global mortality. Aim The effectiveness of the multimodal low-opioid anesthesia technique in performing coronary artery bypass graft operations with artificial blood circulation. Material and methods Ninety-six patients aged 61.8 ±10.4 years underwent coronary artery bypass grafting under artificial blood circulation. Group I: propofol, sevoflurane, fentanyl, pipecuronium bromide (standard doses). Group II: dexketoprofen trometamol (50 mg), intravenous lidocaine (1% – 1 mg/kg bolus) and continuous lidocaine infusion (1.5–2 mg/kg/h), propofol, ketamine (0.5 mg/kg), magnesia sulfate, minimal doses of fentanyl. Results Average duration of anesthesia – 257.4 ±19.1 min; assisted blood circulation – 55 ±10 min. Mean dose of fentanyl in group I – 4.66 ±1.58 µg/kg/h, in group II – 1.29 ±0.32 µg/kg/h.Standard lab values and stress hormonal changes were within the normal range (mean cortisol: 479.3 ±26.4 nmol/l, lactate 1.61 ±0.2 mmol/l, glucose 6.42 ±0.9 mmol/l). Changes in heart rate within group I had a significant amplitude of dynamics, while in group II, these values were relatively at the same level throughout the entire anesthetic provision. Mean arterial pressure changes in group I were characterized by a significant reduction at the stage of induction, support and sternum reduction, whereas in group II it was relatively at the same level during the entire anesthetic management and significantly differed from baseline only at the stage of induction. Conclusions Multimodal low-opioid anesthesia during coronary artery bypass surgery with artificial blood circulation allows one to ensure adequate analgesia and avoid the intraoperative usage of routine doses of fentanyl, as indicated by the absence of hemodynamic and endocrine-metabolic changes.

Opioid-free anesthesia versus opioid-based anesthesia in patients undergoing cardiovascular and thoracic surgery: a meta-analysis and systematic review

“…10 Another CABG study revealed that multimodal low-opioid anesthesia was associated with absent hemodynamic and endocrine-metabolic changes compared to a “standard” opioid-anesthesia group. 42 In regard to ventilation differences, opioid-induced respiratory depression is well-described due to the drug’s action on mu-opioid receptors. 43 As mu-opioid receptors are dispersed throughout the brainstem respiratory network, opioids act specifically by modulating activity of the medullary pre-Bötzinger complex and the pontine Kölliker-Fuse nucleus, which are responsible for stabilizing respiratory rate and pattern.…”

Аssessment of the antinociceptive efficacy of varieties of multimodal low-opioid general anesthesia during laparoscopic renal surgery

“…Методика ММЗА дуже швидко набула популярності і стала досить широко використовуватись в різних областях хірургії, починаючи від абдомінальної хірургії (де наркотичні анальгетики додатково до всього поглиблювали і подовжували п/о парез кишківника) [21,22], до кардіохірургії, де інтраопераційне використання малих доз опіатів зменшувало виразність і тривалість наркотичної депресії в раньому п/о періоді, особливо, у пацієнтів похилого віку [23][24][25].…”